European Journal of Cardiovascular Medicine

Postoperative nausea and vomiting (PONV) is a significant concern for both patients and healthcare providers in the perioperative setting. It is defined as nausea, vomiting, or retching occurring within the first 24-48 hours after surgery, with an incidence ranging from 20% to 30% in the general surgical population and up to 80% in high-risk patients [1,2]. Despite advances in anesthetic techniques and pharmacological interventions, PONV remains one of the most common and distressing complications following anesthesia. It can lead to increased postoperative discomfort, delayed recovery, prolonged hospital stay, and higher healthcare costs [3].

The etiology of PONV is multifactorial, involving patient-related, surgical, and anesthetic factors. Patient-related factors include female gender, nonsmoking status, history of motion sickness or previous PONV, and younger age [4]. Surgical factors encompass the type and duration of surgery, with procedures such as laparoscopy, gynecological, and ENT surgeries being associated with higher incidences of PONV [5]. Anesthetic factors involve the use of volatile anesthetics, nitrous oxide, and opioids, which are known to increase the risk of PONV [6]. Identifying patients at high risk for PONV is crucial for implementing effective prophylactic measures and tailoring anesthetic management to minimize this complication.

Various strategies have been employed to manage PONV, including pharmacological and non-pharmacological approaches. Pharmacological interventions include the use of antiemetic agents such as serotonin receptor antagonists (e.g., ondansetron), dopamine antagonists (e.g., droperidol), and corticosteroids (e.g., dexamethasone) [7,8]. Non-pharmacological methods involve acupuncture, acupressure, and ensuring adequate hydration [9]. Combination therapy, targeting different pathways involved in the emetic response, has been shown to be more effective than monotherapy in preventing PONV [10].

Despite the availability of various antiemetic agents and prophylactic strategies, PONV continues to be a persistent issue. The variability in individual responses to antiemetic medications and the presence of multiple risk factors make it challenging to predict and prevent PONV effectively. Therefore, ongoing research is essential to improve our understanding of the mechanisms underlying PONV and to develop more effective prevention and treatment protocols [11].

In the context of SRM Medical College Hospital, understanding the incidence and management of PONV is particularly relevant. This institution, located in Bhawanipatna, Odisha, serves a diverse patient population with varying health profiles and surgical needs. Studying PONV in this setting can provide valuable insights into the effectiveness of current management practices and highlight areas for improvement. Moreover, it can contribute to the broader body of knowledge on PONV, offering data that may be applicable to similar healthcare settings in India and other developing countries.

This study aims to investigate the incidence of PONV in patients undergoing general anesthesia at SLN Medical College Hospital, identify the associated risk factors, and evaluate the effectiveness of different management strategies. By analyzing data from a range of surgical procedures and patient demographics, this research seeks to provide a comprehensive overview of PONV in this setting and to propose evidence-based recommendations for its prevention and management.

The objectives of this study are threefold: first, to determine the incidence of PONV in patients undergoing various types of surgeries under general anesthesia; second, to identify patient-related, surgical, and anesthetic factors that are significantly associated with an increased risk of PONV; and third, to evaluate the effectiveness of current antiemetic prophylaxis and treatment protocols in preventing and managing PONV.

The findings from this study will be of significant importance to anesthesiologists, surgeons, and other healthcare providers involved in perioperative care at SLN Medical College Hospital. By providing a detailed analysis of PONV incidence and its associated risk factors, this research will help in identifying high-risk patients who may benefit from tailored prophylactic strategies. Additionally, the evaluation of current management practices will offer insights into their effectiveness and suggest potential areas for improvement.

PONV remains a prevalent and distressing complication in the postoperative period, despite the availability of various preventive and treatment measures. Understanding its incidence and management in specific healthcare settings, such as SLN Medical College Hospital, is crucial for improving patient outcomes and enhancing the quality of perioperative care. This study aims to contribute to this understanding by providing a detailed analysis of PONV in a diverse patient population and offering evidence-based recommendations for its prevention and management.

The primary objectives of this study are to investigate the incidence, risk factors, and management of postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia at SRM Medical College Hospital,  Bhawanipatna, Odisha. The specific objectives are as follows:

1. Determine the Incidence of PONV:
• To assess the overall incidence of PONV in patients undergoing various surgical procedures under general anesthesia at SLN Medical College Hospital.
• To categorize the incidence of PONV based on different types of surgeries, such as laparoscopic, gynecological, and ENT surgeries.
2. Identify Patient-Related Risk Factors for PONV:
• To identify and analyze patient-related factors that contribute to an increased risk of PONV, including age, gender, smoking status, history of motion sickness, and previous episodes of PONV.
3. Evaluate Surgical and Anesthetic Risk Factors for PONV:
• To examine the association between the type and duration of surgery and the incidence of PONV.
• To investigate the impact of different anesthetic agents and techniques, including the use of volatile anesthetics, nitrous oxide, and opioids, on the occurrence of PONV.

Study Design

This was a prospective observational study conducted at SRM Medical College Hospital, Bhawanipatna, Odisha. The study aimed to investigate the incidence, risk factors, and management strategies for postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia.

Study Population

The study population comprised patients who underwent various surgical procedures under general anesthesia at SLN Medical College Hospital. The inclusion criteria were as follows:

• Patients aged 18 years and above.
• Patients scheduled for elective surgery under general anesthesia.
• Patients who provided informed consent to participate in the study.

The exclusion criteria were:

• Patients with a known allergy to antiemetic medications.
• Patients with a history of chronic nausea and vomiting unrelated to surgery.
• Patients undergoing emergency surgeries.

Sample Size

A total of 130 patients were included in the study. This sample size was determined based on previous studies and the expected incidence of PONV in the population.

Data Collection

Data were collected over a six-month period from January to June. The following data were recorded for each patient:

1. Demographic Information:
• Age
• Gender
• Body mass index (BMI)
• Smoking status
• History of motion sickness
• Previous episodes of PONV
2. Surgical Information:
• Type of surgery
• Duration of surgery
3. Anesthetic Information:
• Type of anesthesia used (volatile anesthetics, nitrous oxide, opioids)
• Duration of anesthesia
• Use of prophylactic antiemetics (type and dose)
4. Incidence of PONV:
• Occurrence of nausea, vomiting, or retching within 24-48 hours postoperatively
• Severity of PONV (mild, moderate, severe)
5. Management of PONV:
• Pharmacological interventions used for PONV (type and dose of antiemetics)
• Non-pharmacological interventions used (e.g., acupuncture, acupressure)
• Patient outcomes (resolution of PONV, need for additional treatment)

Data Analysis

Data were entered into a database and analyzed using statistical software (e.g., SPSS). The following analyses were performed:

1. Descriptive Statistics:
• Frequencies and percentages for categorical variables.
• Means and standard deviations for continuous variables.
2. Incidence of PONV:
• Calculation of the overall incidence of PONV.
• Incidence rates stratified by type of surgery, type of anesthesia, and use of prophylactic antiemetics.
3. Risk Factor Analysis:
• Univariate analysis to identify potential risk factors for PONV.
• Multivariate logistic regression analysis to determine independent risk factors for PONV.
4. Effectiveness of Prophylactic and Therapeutic Interventions:
• Comparison of the incidence and severity of PONV between patients receiving different prophylactic antiemetic regimens.
• Evaluation of the effectiveness of non-pharmacological interventions in managing PONV.

Ethical Considerations

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Ethics Committee of SLN Medical College Hospital. Written informed consent was obtained from all participants prior to their inclusion in the study. Confidentiality of patient data was maintained throughout the study.

Demographic Characteristics

The study included a total of 130 patients undergoing various surgical procedures under general anesthesia at SLN Medical College Hospital. The demographic characteristics of the study population are summarized in Table 1.

Table 1: Demographic and Clinical Characteristics of Study Participants

Surgical and Anesthetic Factors

Table 2: Surgical and Anesthetic Details

Incidence of PONV

Among the 130 patients included in the study, 40 patients (30.8%) experienced postoperative nausea and vomiting (PONV) within the first 24-48 hours after surgery. The severity of PONV varied, with 15 patients (11.5%) experiencing mild symptoms, 20 patients (15.4%) experiencing moderate symptoms, and 5 patients (3.8%) experiencing severe symptoms.

Factors Associated with PONV

Patient-Related Factors

Patient-related factors associated with an increased risk of PONV included a history of motion sickness (OR 2.5, 95% CI 1.1-5.7, p=0.028) and previous episodes of PONV (OR 3.2, 95% CI 1.5-6.9, p=0.012).

Surgical and Anesthetic Factors

Surgical factors such as laparoscopic surgeries (OR 2.1, 95% CI 1.0-4.4, p=0.041) and longer duration of surgery (OR 1.8, 95% CI 1.2-2.6, p=0.006) were significantly associated with an increased incidence of PONV. Among anesthetic factors, the use of volatile anesthetics (OR 2.5, 95% CI 1.3-4.8, p=0.007) and opioids (OR 1.9, 95% CI 1.1-3.4, p=0.024) were identified as significant risk factors for PONV.

Table 3: Factors Associated with Postoperative Nausea and Vomiting

Effectiveness of Prophylactic Interventions

The effectiveness of prophylactic antiemetic interventions in preventing PONV was evaluated. Among patients who received prophylactic antiemetics (n=100), 25 patients (25%) still experienced PONV, indicating a partial effectiveness rate of 75%. Combination therapy with serotonin receptor antagonists and corticosteroids showed a higher effectiveness compared to monotherapy with serotonin receptor antagonists alone.

Management of PONV

Pharmacological interventions were successfully used to manage PONV in the majority of cases. The most commonly used antiemetic agents included ondansetron, droperidol, and dexamethasone, administered either alone or in combination depending on the severity of symptoms.

Postoperative nausea and vomiting (PONV) is a common complication following surgery, affecting patient recovery and satisfaction. This study aimed to explore the incidence, associated risk factors, and management strategies for PONV among patients undergoing general anesthesia at SRM Medical College Hospital in Bhawanipatna, Odisha.

The study found a notable incidence of PONV, with 30.8% of patients experiencing symptoms within the first 24-48 hours post-surgery. This figure aligns with previous research indicating PONV as a prevalent issue in surgical settings (12).

Several factors were identified as significant predictors of PONV in this cohort. Patient-related factors such as a history of motion sickness (OR 2.5, 95% CI 1.1-5.7, p=0.028) and previous episodes of PONV (OR 3.2, 95% CI 1.5-6.9, p=0.012) were strongly associated with increased risk. These findings corroborate existing literature highlighting the predictive value of these factors (13).

Surgical factors also played a role, with laparoscopic procedures (OR 2.1, 95% CI 1.0-4.4, p=0.041) and longer surgery durations (OR 1.8, 95% CI 1.2-2.6, p=0.006) significantly increasing the likelihood of PONV. Anesthetic factors, particularly the use of volatile anesthetics (OR 2.5, 95% CI 1.3-4.8, p=0.007) and opioids (OR 1.9, 95% CI 1.1-3.4, p=0.024), were also identified as contributors to PONV incidence (14).

The effectiveness of prophylactic antiemetics in preventing PONV was partially successful, with a 25% incidence rate observed despite their use in 76.9% of cases. This underscores the need for improved prophylactic strategies or alternative interventions to mitigate PONV risk effectively (15).

These findings suggest the importance of personalized perioperative care plans tailored to individual patient profiles to minimize PONV incidence and improve postoperative outcomes. Future research should explore novel prophylactic interventions and refine predictive models to enhance PONV management strategies.

In conclusion, this study enhances our understanding of PONV in the context of general anesthesia at SLN Medical College Hospital. By identifying key risk factors and evaluating current management approaches, this research contributes valuable insights that can inform clinical practice and optimize patient care strategies to reduce PONV burden effectively.

1. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109(5):742-53.
2. Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014;118(1):85-113.
3. Tramèr MR, Phillips C, Reynolds DJ, McQuay HJ, Moore RA. Cost-effectiveness of ondansetron for postoperative nausea and vomiting. Anaesthesia. 1999;54(3):226-34.
4. Wang JJ, Ho ST, Tzeng JI, Tang CS. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg. 2000;91(1):136-9.
5. Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89(6):1352-9.
6. Sneyd JR, Carr A, Byrom WD, Bilski AJ. A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. Eur J Anaesthesiol. 2002;19(5):349-62.
7. Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg. 1994;78(1):7-16.
8. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350(24):2441-51.
9. Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth. 1992;69(7 Suppl 1):24S-32S.
10. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992;77(1):162-84.
11. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534-40.
12. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91(3):693-700.
13. Walder B, Schafer M, Henzi I, Tramer MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand. 2001;45(7):795-804.
14. Murphy GS, Szokol JW, Greenberg SB, Avram MJ, Vender JS, Nisman M. Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy: effect on in-hospital and postdischarge recovery outcomes. Anesthesiology. 2011;114(4):882-90.
15. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89(3):652-8.